CTS: VA Study of NSCLC Finds Better Survival for Black Patients

Action Points

Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.

Explain that in a retrospective analysis of cancer data from the Veterans Affairs medical centers, black patients with non-small cell lung cancer had better overall survival compared with white patients.

Note that the significant improved median survival for both stage III and IV disease occurred despite the fact that black patients tended to present with more advanced disease and were less likely to receive recommended therapy.

In fact, in a study of Veterans Affairs medical centers, black patients had a significantly lower risk of dying during follow-up than their white counterparts (HR 0.93, 95% CI 0.91 to 0.95), according to Apar Kishor Ganti, MD, of the University of Nebraska in Omaha.

That was despite presenting with more advanced disease and having a lower likelihood of receiving recommended treatment, Ganti reported at the Chicago Multidisciplinary Symposium in Thoracic Oncology.

Victoria Villaflor, MD, of the University of Chicago, said she wondered whether the mortality difference resulted from the chemotherapy received or because of tumor biology, noting that studies have found a decrease in KRAS mutations in black patients with NSCLC.

"This may have something to do with it, but it's likely not the whole story," she said. "So this is something that we may want to investigate further to see if there are other things that we can find to target."

Racial disparities in NSCLC outcomes in the U.S. have been well documented, and Ganti said that it was believed that poor general health and worse access to healthcare for blacks might provide at least a partial explanation. Even in settings with equal access to care, blacks have been shown to be less likely to receive aggressive treatment.

Ganti and his colleagues performed a retrospective analysis of patients included in the VA Central Cancer Registry -- which collects information from all 143 Department of Veterans Affairs medical centers -- to see whether the disparate outcomes are a function of disease severity at baseline or a result of differences in treatment.

They analyzed data from 95,425 patients diagnosed from January 1995 through February 2009. As expected from a VA population, nearly all of the patients were male (98%).

The majority of the patients were former or current smokers (82%) and were white (82%); 17% were black.

At presentation, black patients had worse disease characteristics. They were less likely than whites to have stage I or II disease (20% versus 22%) and to have a tumor grade of I or II (16% versus 18%). Black patients were also more likely to be current smokers (51% versus 49%). All differences were significant at P<0.001.

Consistent with previous studies, white patients were more likely to receive recommended stage-appropriate treatment. For stage I disease, they were more likely to undergo surgery (46% versus 40%). And for stage IV disease, whites were more likely to get chemotherapy (23% versus 19%). Both differences were significant at P<0.001.

Nevertheless, in a multivariate analysis, black patients had a 7% lower relative risk of death during the study (P<0.001).

The fact that the survival advantage in black patients was more evident in later-stage disease raises the question of whether there is a differential response to chemotherapy by race, Ganti said.

He said possible genetic mechanisms underlying a better response should be investigated, which would give a better understanding of lung cancer biology in patients with different racial or ethnic backgrounds.

Ganti and his co-authors reported that they had no conflicts of interest.

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